Nagler Arnon, Labopin Myriam, Dholaria Bhagirathbhai, Wu Depei, Choi Goda, Aljurf Mahmoud, Ciceri Fabio, Gedde-Dahl Tobias, Meijer Ellen, Niittyvuopio Riitta, Bondarenko Sergey, Bourhis Jean Henri, Cornelissen Jan J, Socié Gerard, Koc Yener, Canaani Jonathan, Savani Bipin, Bug Gesine, Spyridonidis Alexandros, Giebel Sebastian, Brissot Eolia, Bazarbachi Ali, Esteve Jordi, Mohty Mohamad
Chaim Sheba Medical Center, Tel Hashomer, Israel and ALWP Office, Hôpital Saint-Antoine, Paris, France.
Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France; Sorbonne University, INSERM, Saint-Antoine Research Centre, Paris, France.
Transplant Cell Ther. 2022 Feb;28(2):86.e1-86.e8. doi: 10.1016/j.jtct.2021.11.013. Epub 2021 Nov 29.
Cyclosporine A (CSA) and methotrexate (MTX) is the standard graft-versus-host disease (GVHD) prophylaxis regimen for matched sibling donor (MSD) allogeneic hematopoietic cell transplantation (allo-HCT). Recently, post-transplantation cyclophosphamide (PTCy) has been shown to be effective in GVHD prevention. In this registry-based study, we compared outcomes of 118 patients treated with PTCy and 1202 patients with CSA/MTX who underwent MSD allo-HCT for acute myelogenous leukemia. In a matched-pair analysis, PTCy was associated with a higher incidence of relapse at 2 years compared with CSA/MTX (41.1% versus 21.3%; P = .039). The incidences of day +180 grade II-IV acute GVHD and 2-year chronic GVHD were comparable in the PTCy and CSA/MTX arms (25.2% versus 25.4% [P = .90] and 42.6% versus 42.6% [P = .84], respectively). Similarly, 2-year leukemia-free survival (LFS; 54.4% versus 74.32%; P = .052), overall survival (OS; 70.6% versus 79.7%; P = .15), and GVHD-free relapse-free survival (GRFS; 38.1% versus 52.5%; P = .49) were not statistically different in the 2 arms. Our data show that GVHD prophylaxis with PTCy is feasible, resulting in similar incidences of GVHD, GRFS, LFS, and OS as seen with conventional CSA/MTX in patients undergoing allo-HCT from an MSD. The higher rate of relapse observed with PTCy needs further evaluation in a prospective study. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
环孢素A（CSA）和甲氨蝶呤（MTX）是匹配同胞供体（MSD）异基因造血细胞移植（allo-HCT）预防移植物抗宿主病（GVHD）的标准方案。最近，移植后环磷酰胺（PTCy）已被证明在预防GVHD方面有效。在这项基于登记处的研究中，我们比较了118例接受PTCy治疗的患者和1202例接受CSA/MTX治疗的患者的结局，这些患者均接受了MSD allo-HCT治疗急性髓性白血病。在配对分析中，与CSA/MTX相比，PTCy在2年时的复发率更高（41.1%对21.3%；P = 0.039）。PTCy组和CSA/MTX组中+180天II-IV级急性GVHD和2年慢性GVHD的发生率相当（分别为25.2%对25.4% [P = 0.90]和42.6%对42.6% [P = 0.84]）。同样，两组的2年无白血病生存率（LFS；54.4%对74.32%；P = 0.052）、总生存率（OS；70.6%对79.7%；P = 0.15）和无GVHD无复发生存率（GRFS；38.1%对52.5%；P = 0.49）在统计学上无差异。我们的数据表明，在接受MSD allo-HCT的患者中，用PTCy预防GVHD是可行的，其GVHD、GRFS、LFS和OS的发生率与传统的CSA/MTX相似。PTCy观察到的较高复发率需要在前瞻性研究中进一步评估。© 2021美国移植与细胞治疗学会。由爱思唯尔公司出版。
